4 Group Health Centre Shared Care Pilot Sites Rural and Northern Physician Group Agreement Section 4 HealthForceOntario Background Two Ministries: One Division, One ADM What is HealthForceOntario? How Does HealthForceOntario Fit with Other Health Initiatives? HealthForceOntario Initiatives Better Data and More Expertise in Health Human Resources Planning Better Use of Provider Knowledge and Skills...56 Stronger Links Between the Colleges and Universities, and the Health System More Education Opportunities Interprofessional Education and Practice Making Ontario the Employer-of-Choice! For More Information Appendix A Colleges Legislated under the Regulated Health Professions Act Appendix B Professional Associations for Professions under Ontario Regulated Health Professions Act Appendix C Statistics Fact Sheets for the Regulated Health Care Professions References Page ii

5 Preface The Health Human Resources Toolkit is produced by the Health System Intelligence Project (HSIP), in partnership with the Health Human Resources Strategy Division (HHRSD). HSIP consists of a team of health system experts retained by the Ministry of Health and Long-Term Care s Health Results Team for Information Management to provide the Local Health Integration Networks (LHINs) with: Sophisticated data analysis Interpretation of results Orientation of new staff to health system data analysis issues Training on new techniques and technologies pertaining to health system analysis and planning The Health Results Team for Information Management created the Health System Intelligence Project to complement and augment the existing analytical and planning capacity within the Ministry of Health and Long-Term Care (MOHLTC). The project team is working in concert with Ministry analysts to ensure that LHINs are provided with the analytic supports they need for their local health system planning activities. The Health Human Resources Strategy Division was established in 2005 as part of the Government s overall health strategy to increase the supply of appropriately educated health professionals in Ontario to address the needs of the public. HHRSD is responsible for the development of a strategic plan to address the issues of supply, mix, education and distribution of health professionals. This includes developing an implementation plan to improve the province s supply of professional medical resources and labour market policies to allow movement of health professional across an integrated health care system. The Assistant Deputy Minister of HHRSD is responsible for this commitment and has a unique dual reporting relationship to the Deputy Minister, MOHLTC, and the Deputy Minister, Ministry of Training, Colleges and Universities. Report Authors Sten Ardal Caroline Abrahams Dawn Olsen (Lead Author) Hussein Lalani Anshoo Kamal Acknowledgements The Health System Intelligence Project and the Health Human Resources Strategy Division wish to acknowledge and thank the many individuals that contributed to the development of the Health Human Resources Toolkit including Registrars and staff from the: College of Audiologists and Speech-Language Pathologists of Ontario (CASLPO) College of Chiropodists of Ontario College of Chiropractors of Ontario College of Dental Hygienists of Ontario Royal College of Dental Surgeons of Ontario College of Dental Technologists of Ontario College of Denturists of Ontario College of Dietitians of Ontario College of Massage Therapists of Ontario College of Medical Laboratory Technologists of Ontario College of Medical Radiation Technologists College of Midwives of Ontario College of Nurses of Ontario College of Occupational Therapists of Ontario College of Opticians of Ontario College of Optometrists of Ontario Ontario College of Pharmacists College of Physicians and Surgeons of Ontario College of Physiotherapists of Ontario College of Psychologists of Ontario College of Respiratory Therapists of Ontario Numerous program areas and units within the Ministry of Health and Long-Term Care Preface Page iii

6 This Toolkit s Purpose General Context There is no more crucial element in the delivery of health services in Canada than its human resources. The health care system relies on the services of trained health professionals to deliver health care. Between 60 and 80 cents of every health care dollar in Canada is spent on health human resources (excluding the cost of educating health care providers). 1 The health care system is extremely complex. Most health professions in Canada are self-regulatory but to varying degrees across provinces. Some professionals are self-employed in community-based private practice while others are employed within public institutions or community agencies. Some, but not all, health care workers operate under collective agreements. Health care professionals also differ by education level. For instance, some professions require a community college diploma while a university degree and postgraduate training is required for other professions, and the requirements are often changing. Some professions may be compensated fully through publicly financed programs while others are largely compensated privately through insurance or direct out-of-pocket payments by patients. All jurisdictions in Canada are experiencing health care provider shortages, longer waiting lists for many services, and escalating costs. In Ontario, there are over 350,000 2 health care providers but shortages of certain health professionals and skills are still being faced and may worsen in the future without appropriate health human resources planning. Ontario is facing competition in recruiting health care professionals from other provinces, the United States and other countries. Indeed, health human resources are identified as a scarce resource in many jurisdictions and a leading contributor to costs. For example, roughly 75% of Ontario s health sector costs are for health human resources. In fiscal year 2003/04, publicly funded health expenditures for community care access centres (CCACs), community health centres (CHCs), long-term care homes, public hospitals and substance abuse programs was more than $14 billion. ii;3 Importance of Health Human Resources Planning The potential for a health human resources crisis, exacerbated by the looming demographic shift of both patients and providers, means it is time to rethink the health workforce and how it is planned and managed. Health human resources planning is undergoing a shift toward interprofessional practice, which is based on having different providers working together to meet population health needs. This is evident in primary care delivery models being developed. Over the next 10 years, Ontario will pursue a range of strategies designed to develop new models of practice and remove barriers that prevent the most effective and efficient use of the health workforce. Examples of models include family health teams, community health centres, assertive community treatment teams and early intervention teams. Health care workers are, and will continue to be encouraged to work to their full scope of practice to allow them to use their full knowledge and skills in order to make more efficient use of the existing workforce. For example, it is expected that the health care system will see greater use of advanced practice nurses in acute care settings, greater use of nurse practitioners and pharmacists in long-term care and home care, as well as the more effective use of the skills of personal support workers and other unregulated providers in complex continuing care, long-term care and home care. Over the past decade and more, the health system has recognized and supported a number of professions, such as midwives, to meet population health needs. It has also introduced new roles, such as the primary care nurse practitioner, advanced practice nurses, physiotherapy assistants, and pharmacy assistants. Recently, the health care system began using respiratory therapists and nurses working within their existing scope of practice to monitor sedation for patients receiving cataract surgery. It was this use of nurses and respiratory therapists that have allowed Ontario to reduce wait times for cataract surgery. Moving forward, Ontario will continue to explore the potential for new professions and roles, based on population health needs. i ii Includes both regulated and unregulated health care workers. Expenditures for 2003/04 are for health programs funded by the Ontario government and refer to actual payments that have been made. It does not include out-ofpocket expenditures or funding provided by other sources, such as federal or municipal governments. Page iv This Toolkit s Purpose

7 Health human resources planning by LHINs can contribute to the creation of systems that support health care providers in working to their full competencies and skills. Within the system there are barriers that make it difficult to change practice or to make effective use of all providers skills. Some of those barriers are attitudinal, and they will gradually be broken down through education and experience. Some are financial, as the incentives in the system do not always encourage or reward interprofessional practice or effective use of all skills. Some barriers may be the result of the legislative and regulatory frameworks that exist for the various professions within the health care sector. Some are a by-product of collective bargaining agreements and concerns about liability. LHINs can work to identify and address other barriers to making effective use of the health workforce. The health human resources planning history has regularly revisited the same questions of supply, provider mix, distribution, regulation, scope of practice, remuneration and training. The next step is to consider how each of these factors interact as a whole. There is no question that the issues affecting health human resources in Ontario are complex. The multifaceted nature of health human resources suggests the need for coordinated health human resources planning with changes to system design and to incorporate the interests of sectors, stakeholders and jurisdictions to effectively meet population health needs. Use of evidence, planning tools and best practices will contribute to health human resources planning that is comprehensive. Purpose of the Toolkit The Health Human Resources Toolkit represents a high level reference tool for understanding the organization of health human resources in Ontario. Through extensive information gathering, this toolkit compiles relevant planning information in one place. In taxonomy format, the information is intended to provide a foundation for understanding how the health workforce in Ontario is organized and governed, with a broad overview of the supply of regulated health care professions, where available. The toolkit is organized as follows: Regulated health care professions in Ontario Occupation profiles for regulated health care professions Provincial programs that address supply and distribution of health human resources Primary care delivery models in Ontario HealthForceOntario: a new health human resources strategy This Toolkit s Purpose Page v

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9 Section 1.0 What are Regulated Health Care Professions? In Ontario, regulated health professions are governed under the Regulated Health Professions Act, 1991 (RHPA) and profession-specific Acts which are its companion pieces. Currently, there are 24 regulated health professions which are governed by laws administered by the MOHLTC, under the RHPA. 1.1 Self-regulation under the Regulated Health Professions Act, 1991 (RHPA) The objective of self-regulation under the RHPA is to protect the public from incompetent and unqualified individuals and to promote informed consumer choice through a system of scope of practice statements, controlled acts, protected titles, standards of practice and complaints and discipline processes. Each profession-specific Act establishes a regulatory college with a governing council comprising a majority of elected professional members and a minority of publicly appointed individuals. Regulatory Colleges Each health profession-specific Act establishes a selffinancing, nonprofit regulatory college which is responsible for implementation of the RHPA. Regulatory colleges are not teaching institutions. Rather, they are the regulatory bodies for health professions and serve the public interest by: regulating the practice of the professions and governing their members in accordance with the legislation; setting registration requirements for entry-to-practice into the professions; developing and maintaining quality assurance programs that promote the continuing competence of members; developing standards of practice that establish how members do their jobs in an effective, safe and ethical manner; implementing complaints and discipline processes; and fulfilling other objects relating to human health care that the College Council finds desirable. Appendix A contains a list of the 22 health regulatory colleges in Ontario. Although most regulated health professions in Ontario have their own college, there are a few exceptions such as the College of Audiologists and Speech-Language Pathologists regulates both speech-language pathologists and audiologists and the College of Chiropodists of Ontario regulates both chiropodists and podiatrists. As a result, the 22 health regulatory colleges govern 24 regulated health professions. The Federation of Health Regulatory Colleges of Ontario (FHRCO) is a body that represents the common interests of all the health regulatory colleges. For additional information, please refer to FHRCO s website at What is the RHPA? The RHPA 4 is legislation that provides a comprehensive framework for regulating the provision of most health services in Ontario and serves to help protect patients and the public by ensuring that practitioners meet agreed standards of practice and competencies. The RHPA comprises two schedules: Schedule 1 includes provisions with respect to duties and powers of the Minister, the Health Professions Advisory Council (HPRAC), list of controlled acts and other prohibitions. The Health Professions Procedural Code (Code) is Schedule 2 and consists of rules to be followed by the colleges in registering their members, handling complaints, conducting investigations and conducting discipline and fitness to practice proceedings. The Code also sets out: general objects of the regulatory colleges and duties and powers of their councils; the basic obligation of each college to establish and administer quality assurance and patient relations programs; mandatory reporting obligations; and provisions regarding funding for victims of sexual abuse. Section 1: What are Regulated Health Care Professions? Page 1

10 The information presented in the following sections provides the reader with a general understanding of the RHPA and is not intended as a definitive legal explanation of the legislation. For specific wording, the reader is advised to consult the actual legislation. The RHPA can be viewed in its entirety at Profession-specific Acts Within the framework of the RHPA, there are a series of profession-specific acts that specify such things as the scope of practice, authorized acts (if any), the title or titles restricted to members of the profession and a small number of other provisions that vary from profession to profession, including the composition of the college council and any special regulation-making authorities. Additionally, each profession-specific Act also contains a section deeming the Code to be part of that Act. Below is a list of all the regulated health professions in Ontario and their corresponding profession-specific Act Roles and Responsibilities The RHPA assigns duties and responsibilities to the Minister of Health and Long-Term Care, regulatory colleges, the Health Professions Regulatory Advisory Council (HPRAC) and the Health Professions Appeal and Review Board (HPARB). The duties and responsibilities are described in the following sections. The Minister of Health and Long-Term Care The Minister of Health and Long-Term Care has a duty to confirm that the regulatory colleges develop and maintain standards for the professions they regulate. The RHPA specifies that the Minister may direct a college to: determine the state of practice in a particular area or institution; provide reports and information about its activities; make, change or repeal a regulation made under a health profession Act or the Drug and Pharmacies Regulation Act (DPRA); and follow through on any activity the Minister believes should be done to carry out the intent of the RHPA, a profession-specific Act or the DPRA. Profession Profession-specific Act Audiology and Speech-Language Pathology Audiology and Speech-Language Pathology Act, 1991 Chiropody/Podiatry Chiropody Act, 1991 Chiropractic Chiropractic Act, 1991 Dental Hygiene Dental Hygiene Act, 1991 Dentistry Dentistry Act, 1991 Dental Technology Dental Technology Act, 1991 Denturism Denturism Act, 1991 Dietetics Dietetics Act, 1991 Massage Therapy Massage Therapy Act, 1991 Medical Laboratory Technology Medical Laboratory Technology Act, 1991 Medical Radiation Technology Medical Radiation Technology Act, 1991 Midwifery Midwifery Act, 1991 Nursing Nursing Act, 1991 Occupational Therapy Occupational Therapy Act, 1991 Opticianry Opticianry Act, 1991 Optometry Optometry Act, 1991 Pharmacy Pharmacy Act, 1991 Medicine Medicine Act, 1991 Physiotherapy Physiotherapy Act, 1991 Psychology Psychology Act, 1991 Respiratory Therapy Respiratory Therapy Act, 1991 Traditional Chinese Medicine Traditional Chinese Medicine Act, 2006 iii iv Refers to the professions of Audiology and Speech-Language Pathology Refers to the professions of Chiropody and Podiatry Page 2 Section 1: What are Regulated Health Care Professions?

11 The Minister may also refer any matter concerning the regulation of health professions to HPRAC for its review and recommendations. The Minister also has an obligation, on request from a college council or individual to refer any matter concerning the regulation of health professions to HPRAC. However, there is no timeline specified in legislation when the Minister must refer the matter to HPRAC. The Health Professions Regulatory Advisory Council (HPRAC) HPRAC is an arms-length agency to the ministry with a mandate to advise the Minister on issues related to the regulation of health professions in Ontario. Its members are appointed by the government on the recommendation of the Minister. Public servants, Crown employees and past or present members of a regulatory college or college council are not eligible to be a member of HPRAC. HPRAC is responsible for providing the Minister with advice on: which health professions should be regulated or no longer regulated; whether changes should be made to the RHPA or related Acts; whether proposed regulations under the RHPA and related Acts should be made; whether the Colleges programs for complaints and discipline in sexual misconduct, quality assurance and patient relations programs are effective; and any other matter concerning the regulation of health professions that the Minister may wish to refer to the Advisory Council. In developing its recommendations to the Minister, HPRAC seeks input from a variety of sources, including the public, interest groups, health professionals, health regulatory colleges and professional associations. However, it is important to note that HPRAC s advice and recommendations to the Minister are not binding. An example of the activities carried out by HPRAC at the time of this publication, is the release of its 2006 report entitled Regulation of Health Professions in Ontario: New Directions. In its report, HPRAC provided advice and recommendations on regulating several new professions including, but not limited to, psychotherapists, kinesiologists and naturopaths. The Health Professions Appeal and Review Board (HPARB) HPARB is a tribunal that exercises its legislated functions independently of the MOHLTC and whose primary responsibility is to review certain decisions made by college complaints or registration committees when an appeal is made. Through reviews and hearings, HPARB monitors the activities of the colleges complaints and registration committees, in order to ensure they fulfill their duties in the public interest as mandated by legislation. Registration reviews and hearings frequently involve applicants trained and registered to practise in other jurisdictions. Issues of educational equivalency, training, knowledge and skills often arise during these proceedings. HPARB provides a neutral forum for members of the public and health professionals and is obliged to provide its written decision with reasons to the concerned parties and to the College. Further information about HPARB is available at: Scope of Practice All regulated health professions under the RHPA have a scope of practice statement in their profession-specific Act that describes in a general way what the profession does and the methods it uses. For example, the scope of practice statement for pharmacy in the Pharmacy Act, 1991 indicates that: The practice of pharmacy is the custody, compounding and dispensing of drugs, the provision of nonprescription drugs, health care aids and devices and the provision of information related to drug use. It is important to note that the scope of practice statement provides a brief description of a profession s activities, and that the profession does not have the exclusive right to provide services within its scope of practice. Hence, there is no prohibition against an unregulated practitioner performing services within a regulated profession s scope of practice. The scope of practice statement also provides a frame of reference for the performance of controlled acts by regulated professionals, as discussed in the next section. Further information about HPRAC and its current activities is available at 6 Section 1: What are Regulated Health Care Professions? Page 3

12 1.4 Controlled Acts The RHPA identifies 13 health care activities that when performed by unqualified professionals may put the public at substantial risk of harm and are therefore controlled for use by legislation. These controlled acts are authorized by the RHPA to be performed in the course of providing health care services only by certain regulated health professions. Not all health professions are authorized to perform controlled acts; many have some of the controlled acts but with restrictions. For example, some regulated health professions, such as massage therapists, have not been authorized for any controlled acts, while others, such as physicians, have been authorized for many of the controlled acts. Controlled acts are authorized to professionals and are consistent with their scope of practice, educational standards, skills and expertise. These restricted activities are set out in section 27 of the RHPA. The 13 controlled acts are: 7 1. Communicating to the individual or his or her personal representative a diagnosis identifying a disease or disorder as the cause of symptoms of the individual in circumstances in which it is reasonably foreseeable that the individual or his or her personal representative will rely on the diagnosis. 2. Performing a procedure on tissue below the dermis, below the surface of a mucous membrane, in or below the surface of the cornea, or in or below the surfaces of the teeth, including the scaling of teeth. 3. Setting or casting a fracture of a bone or a dislocation of a joint. 4. Moving the joints of the spine beyond the individual s usual physiological range of motion using a fast, low amplitude thrust. 5. Administering a substance by injection or inhalation. 6. Putting an instrument, hand or finger, i. beyond the external ear canal, ii. beyond the point in the nasal passages where they normally narrow, iii. beyond the larynx, beyond the opening of the urethra, iv. beyond the labia majora, v. beyond the anal verge, or vi. into an artificial opening into the body. 7. Applying or ordering the application of a form of energy prescribed by the regulations under this Act. 8. Prescribing, dispensing, selling of the compounding a drug as defined in subsection 117(1) of the Drug and Pharmacies Regulation Act, or supervising the part of a pharmacy where such drugs are kept. 9. Prescribing or dispensing, for vision or eye problems, subnormal vision devices, contact lenses or eye glasses other than simple magnifiers. 10. Prescribing a hearing aid for a hearing impaired person. 11. Fitting or dispensing a dental prosthesis, orthodontic or periodontal appliance or a device used inside the mouth to protect teeth from abnormal functioning. 12. Managing labour or conducting the delivery of a baby. 13. Allergy challenge testing of a kind in which a positive result of the test is a significant allergic response. Additionally, section 30 in the RHPA was added as a tool to prohibit any person other than a regulated health professional practising within the scope of his or her profession from treating or advising a person with respect to his or her health in circumstances where it is reasonably foreseeable that serious physical harm may result from the treatment or advice or from an omission from the treatment or advice. A breach of this section is an offence punishable by a fine, imprisonment for up to 6 months or both. 1.5 Protected Titles Protected titles provide a unique label for individuals or groups of practitioners so that consumers may accurately distinguish between practitioners. Specific practitioners are granted the exclusive use of a particular title so as to set them apart from other regulated and unregulated practitioners. In return for such exclusivity, practitioners are required to adhere to an explicit standard of practice of the profession and to achieve the appropriate qualifications for the use of the title. Consumers may then have reasonable confidence that the health professional of their choice has met minimum standards of knowledge and expertise and is accountable to a governing body. Page 4 Section 1: What are Regulated Health Care Professions?

13 The RHPA sets out the prohibition on the use of the doctor title in providing health care. It exempts five professions: medicine, psychology, dentistry, chiropractic and optometry, and provides the minister with authority to make a regulation to allow additional professions to use the doctor title. The profession of traditional Chinese medicine (TCM) will also be exempt from the prohibition on the use of the doctor title once the amendments to the Traditional Chinese Medicine Act, 2006 are proclaimed into force and the transitional Council for the new College makes a regulation outlining the requirements for members to use this title. 1.6 Ontario Occupation Profiles Occupation profiles for each of the 24 regulated health professions in Ontario are presented in this section. The profile for traditional Chinese medicine practitioners is less detailed as the Act to regulate the profession recently received royal assent in December The transitional Council and the transitional Registrar of the College of Traditional Chinese Medicine Practitioners and Acupuncturists of Ontario will be required to develop the regulatory framework for the profession in accordance with the expectations and requirements set out the RHPA. Each occupational profile presents information under the following headings: NOC Number Description Responsibilities Employment Educational Requirements Other Professional Requirements Access Professional Associations and Related Websites In Appendix C, statistical fact sheets for the regulated health professions are provided. Information presented in the fact sheets includes, where available: Number of Active or Registered Members Sex and Age Distribution Work Status Place of Work Geographic Distribution by LHIN Section 1: What are Regulated Health Care Professions? Page 5

14 Fact Sheet: Audiology Audiologist NOC Number(s) 3141 Note: Classification refers to both audiologists and speech-language pathologists. Description Responsibilities 9 The practice of audiology is the assessment of auditory function and the treatment and prevention of auditory dysfunction to develop, maintain, rehabilitate or augment auditory and communicative functions. 8 Audiologists are responsible for the prevention, identification, assessment, treatment and (re)habilitation of hearing difficulties in children and adults. 9 Audiologists may choose to work with people of all ages or they may work with a particular age group (e.g. infants, seniors, preschoolers). Examples of duties performed are as follows: Evaluate patients to identify the degree, type and location of hearing problems using electronic equipment and specialized instruments. Prescribe, recommend, select, fit and teach clients how to use appropriate assistive listening devices (e.g. hearing aids, telephone adaptors, visual alarms and captioning devices). Plan and implement management programs (e.g. auditory training, instruction in speech reading). Perform cerumen management (ear wax removal); serve on cochlear implant teams; treat vestibular problems such as tinnitus and dizziness. Other: Assess and provide aural habilitation of babies identified under the provincial Infant Hearing Program; sustained audiologic care is essential to maintain and maximize speech, language, cognitive and social development. In Ontario, only audiologists and physicians are authorized to prescribe hearing aids. 10 Employment Audiologists work in a variety of health and educational settings, including, but not limited to: 10 hospitals private practice offices public health units industrial settings community health centres hearing aid manufacturers preschools and schools Some are employed as researchers in hospitals, universities and government agencies (a PhD is usually required); others may be administrators of speech and hearing programs. Audiologists are often part of teams which include physicians, psychologists, social workers, nurses, teachers, occupational therapists, physical therapists, and counsellors. 11 Educational Requirements Other Professional Requirements Access Professional Associations and Related Websites Other The education requirement for audiologists is a master s degree in audiology. Admission to master s degree programs generally requires an acceptable average in a 4 year bachelor s degree program with specified courses. In Ontario, master s degree programs in audiology are offered at the University of Western Ontario, and the University of Ottawa (French). A clinical placement in a hospital, private hearing clinic, rehabilitation centre or health care facility is required before graduation. Candidates must be registered with the College of Audiologists and Speech-Language Pathologists of Ontario (CASLPO), which ensures that clinicians meet stringent professional and ethical standards. Patients do not require a referral from a physician. Audiologists practice independently within their scope of practice. College of Audiologists and Speech-Language Pathologists of Ontario: Presents an overview of the profession and provides legislation directly relevant to the professions of audiology and speech language pathology, registration information and links. Canadian Association of Speech-Language Pathologists and Audiologists (CASLPA): Is the single national body that supports the needs, interests and development of speech-language pathologists, audiologists and supportive personnel across Canada. The Ontario Association of Speech-Language Pathologists and Audiologists: Is a voluntary, not-for-profit association providing its members with provincial advocacy, promotion of the professions, educational opportunities, and professional resources. Canadian Academy of Audiology: Informs members about conferences, newsletters, professional forums and ethical standards of practice in Canada. Ontario Infant Hearing Program: Page 6 Section 1: What are Regulated Health Care Professions?

15 Fact Sheet: Chiropody vi Chiropodist NOC Number(s) 3123 Note: Classification refers to Other Professional Occupations in Health Diagnosing and Treating. Description 12 Responsibilities 13 Employment Educational Requirements Other Professional Requirements Access Professional Associations and Related Websites Chiropody is defined as the assessment of the foot and the treatment and prevention of diseases or disorders of the foot by therapeutic, orthotic and palliative means. Patient care can range from routine nail care to nail surgery, and from mechanical correction of gait and posture to invasive surgical techniques. Chiropodists help patients reduce or eliminate foot pain, improve mobility and function and maintain healthy feet. Chiropodists consult with radiologists and other medical specialists to ensure appropriate and judicious diagnostic investigations. Ordering diagnostic tests to confirm a diagnosis. Chiropodists utilize lasers and other modalities in treating patients. Chiropodists treat a variety of functional foot problems with prescription orthotics. Chiropodists treat sports injuries. In addition, chiropodists treat all common foot problems from corns, warts, ingrown toenails, and fungal and bacterial infections. Chiropodists treat and prevent foot problems that result from systemic disease such as diabetes, arthritis and other medical conditions. Chiropodists treat children to the aged. Chiropodists work primarily in private practice. Chiropodists work with many different health care professionals including family physicians, medical specialists, nurses, physical therapists and pharmacist and interface with social service agencies to improved foot health in challenged populations. Although Chiropodists work in private practice, chiropodists are engaged in consulting in hospitals, community health centres, LHINs, industry, sports teams, occupational and public health units, retirement residences and schools. The Michener Institute for Applied Health Sciences is the only educational institution in Ontario offering a chiropody program. Upon completion of the 3 year program, students received a graduate advanced diploma of health sciences (chiropody). Candidates must have completed an undergraduate baccalaureate from a recognized university to be admitted to the program. Chiropodists also undertake training at a variety of academic institutions in the United Kingdom, South Africa, and Ireland. Chiropodists can also undertake postgraduate training in podiatry in the US or UK leading to MSc and PhD in areas of postgraduate research and specialization. Individuals wishing to practise as a chiropodist in Ontario must be registered with the College of Chiropodists. Registration includes completion of an examination set or approved by the College of Chiropodists. In private practice, chiropodists receive referrals from medical and other health care practitioners and consult with these referring practitioners to provide timely and optimal care for their patients. A referral from a family physician is not required to see a chiropodist. College of Chiropodists of Ontario: Provides information on regulations, legislation, standards and registration for its chiropody members. All chiropodists and podiatrists who work in Ontario are responsible for meeting its standards. The Ontario Society of Chiropodists: Provides information about foot care and foot health in Ontario for both the general public and health professionals in this industry. vi The College of Chiropodists regulates chiropody, which is one profession with two classes of members i.e., chiropodists and podiatrists. The job title for a person registered with the College of Chiropody is Chiropodist. Section 1: What are Regulated Health Care Professions? Page 7

16 Fact Sheet: Chiropractic Chiropractor NOC Number(s) 3122 Description Responsibilities 15 Chiropractors practice a drug-free, manual approach to health care that includes patient assessment, diagnosis and treatment of neuromuscular-skeletal disorders of the spine, pelvis, extremity joints, and their effect on the nervous system. 14 Assess patients by obtaining a patient s case history, conducting an examination, observing the patient and performing X-rays and other tests to diagnose a patient s condition. Diagnose neuromuscular-skeletal disorders of the spinal column, pelvis, extremities and associated tissues. Treat health disorders in a natural manner through adjustments or articular manipulations and complementary treatments such as electrotherapy, nutrition, light and massage with special attention given to the spine. Advise patients on corrective exercises, posture, lifestyle and nutrition. Refer patients for medical care when appropriate. Employment Educational Requirements 14 Other Professional Requirements Access Professional Associations and Related Websites Most chiropractors work in their own clinics or with other chiropractors. Some chiropractors share offices with other health providers such as massage therapists, physiotherapists or family physicians. Chiropractors operate independent practices as sole proprietors or join other chiropractors or health providers to form a clinic. Chiropractors may offer services in the areas of occupational and industrial health, athletic injuries, X-ray interpretation, orthopedics, rehabilitation, nutrition, geriatrics or pediatrics. Chiropractic students undergo 7 years of university level education. Students are required to complete a minimum of 3 years of university before they are eligible for admission to the Canadian Memorial Chiropractic College (CMCC) in Toronto, the only accredited program in Ontario. Approximately 90% of students entering the CMCC program have completed a baccalaureate or graduate degree. The CMCC program requires 4 years of full-time study, including a 12 month internship in CMCC s clinics. To be considered for registration, candidates must, within 2 years of graduation, apply for registration with the Chiropractic College of Ontario (CCO) and successfully complete the CCO Legislation and Ethics examination, the Canadian Chiropractic Examining Board (CCEB) knowledgebased examinations, and the CCEB Clinical Competency examination. The services of a chiropractor are not covered by OHIP. A patient does not have to be referred by a medical doctor. Chiropractors are legislated as primary contact health care professionals which means that patients can consult them directly. Similarly, chiropractors refer to medical doctors when necessary. Most federal government departments (such as RCMP and Veteran s Affairs), all workers compensation boards and most employer and other third party insurance plans cover chiropractic services. 14 College of Chiropractors of Ontario: The governing body established by the provincial government to regulate chiropractors in Ontario. The website provides information regarding regulation, standards of practice and registration. Ontario Chiropractic Association: A voluntary professional association whose mandate is to advance chiropractic health care. Canadian Chiropractic Association: A federated association representing the chiropractic profession in Canada. The website provides facts to help Canadians live healthier lives with chiropractic care and serves as an advocate for the profession. The Canadian Chiropractic Examining Board: The sole examination entity for all chiropractic examinations in Canada. Canadian Federation of Chiropractic Regulatory Boards: A national association of provincial and territorial chiropractic licensing authorities and functions to promote national excellence in regulatory practice. Page 8 Section 1: What are Regulated Health Care Professions?

17 Fact Sheet: Dental Hygiene Dental Hygienist NOC Number(s) 3222 Note: Classification refers to Dental Hygienists and Dental Therapists. Consult with College for regulated field of practice. Description Responsibilities 15 Employment Educational Requirements Other Professional Requirements Access Professional Associations and Related Websites A dental hygienist is a registered oral health professional who performs a variety of roles including clinical therapy, health promotion, education, administration and research in a variety of practice environments. The dental hygienist works with the client/patient and other health professionals and, using a problem solving framework, bases all decisions, judgements, and interventions on current dental hygiene research and theory. 16 In clinical practice, dental hygienists can work within their own practises but most often work with general practitioner dentists or specialty practice dentists. Depending upon the field they practice, dental hygienists may: Assess oral health. Screen individuals for dental problems using radiographic equipment to produce diagnostic information, and take and develop X-rays. Provide therapeutic services and education aimed at the promotion of optimal oral health. Provide nutrition counselling. Provide tobacco cessation programs. Perform restorative and orthodontic procedures under the direction of a dentist. Most dental hygienists work in dental offices but are also employed in hospitals, clinics, educational institutions, government agencies and private industry. Individuals must graduate from an accredited 2 year program, or equivalent, at a college and then successfully complete the Canadian National Dental Hygiene Certification Board Exam. There are currently 17 accredited colleges for dental hygiene in Ontario. 17 Registration is required with the College of Dental Hygienists of Ontario. Most dental hygienists are employed by general practitioner dentists or specialty practice dentists. College of Dental Hygienists of Ontario: The regulatory body for dental hygiene in the province of Ontario. The website contains regulation, standards of practice and registration information. Canadian Dental Hygienists Association: A national not-for-profit organization that represents dental hygienists in Canada offering information for advocacy and education. Ontario Dental Hygienists Association: A nonprofit organization that represents the interest and needs of dental hygienists in Ontario. Section 1: What are Regulated Health Care Professions? Page 9

18 Fact Sheet: Dental Technology Registered Dental Technologist NOC Number(s) 3223 Note: NOC code refers to several types of dental technology expertise, e.g., dental technician, dental technician apprentice and dental technician supervisor. Description Responsibilities 19 Employment 18 Educational Requirements 19 Other Professional Requirements Access Professional Associations and Related Websites A Dental Technologist (RDT) is licensed (registered) by the College of Dental Technologists of Ontario (CDTO). They are knowledgeable and skilled in the design, construction, repair or alteration of dental prosthetic, restorative and orthodontic device, which are prescribed by dentists, or other qualified health care practitioners for their patients. 18 Only a dental technologist can supervise the technical aspects of a dental laboratory operation. An RDT is authorized to design, fabricate, modify, and repair by prescription all or any of the following: complete dentures; partial dentures; crowns and bridges; implants; and appliances used in orthodontics, oral and maxillo-facial surgery and other dental specialties. In addition, a licensed dental technologist is authorized to own and/or supervise a dental laboratory. All work is custom made requiring dental technologists knowledge and expertise in dental materials, fabrication processes, changing technology and dental anatomy. RDTs usually work in dental laboratories, independent of dentists offices. Some work in institutions such as universities, colleges and hospitals that offer dental technology services. Others work as sales representatives with dental supply companies. While working in separate locations, RDTs and dentists work closely together as a team. Dentists rely on RDTs professional judgement in the filling of prescriptions, including assessing and interpreting prescriptions; consulting to jointly consider changes that are beneficial to the patient; determining the shape and contours, material and methods of production. Successful completion of 1) Grade 12 or its equivalent, and 2) An approved program in dental technology at a College of Applied Arts and Technology in Ontario, or at an educational institution outside of Ontario that the CDTO considers to be the equivalent. Employment as a dental technologist in an apprenticeship program, for a period of not less than 1,950 hours, under the supervision of a member of the CDTO or its predecessor, or of a member of the Royal College of Dental Surgeons, or in such other supervised employment outside of the Province of Ontario as the Registration Committee may approve. Successful completion of the certification examinations set or approved by the CDTO, and complied with all requirements associated with those examinations, including payment of the examination fees. Proof of eligibility to acquire professional liability insurance and prior to the issuance of a certificate, must show proof of actual coverage. RDTs do not work directly on patients. They perform their duties based on prescriptions received from dentists, or other qualified health care practitioners. They perform colour-matching when delegated by dentists and assist dentists in planning and treatment procedures as in dental implant cases. College of Dental Technologists of Ontario: The regulatory body that licenses dental technologists. It ensures competency and accountability of dental technologists practicing in Ontario. The website contains information regarding regulations, standards of practice, and registration. Association of Dental Technologists of Ontario: The website provides education, communication amongst members, and liaison with external agencies, with the goals of elevating awareness and excellence for the profession. Page 10 Section 1: What are Regulated Health Care Professions?

19 Fact Sheet: Dentistry Dentist NOC Number(s) 3113 Description Responsibilities 15 Employment Educational Requirements Other Professional Requirements Access Professional Associations and Related Websites Dentists diagnose, treat, prevent and control disorders of the teeth, mouth, and related hard and soft tissues. 15 Dentists perform some or all of the following duties: Promote good dental health by advising patients about oral health care and prevention of diseases or disorders of the oral-facial complex. Examine patients teeth, gums and surrounding tissue to diagnose disease, decay, injury and then plan appropriate treatment. Restore, extract and replace diseased and decayed teeth and provide cosmetic restorative services. Prescribe and dispense drugs for their patients for conditions of the oral-facial complex they are treating. Perform oral surgery, periodontal surgery and other treatments. Clean teeth and instruct patients on oral hygiene. Correct abnormal positioning of the teeth and jaws by designing bridgework and fitting dentures. Write fabrication instructions or prescriptions for use by dental technicians. Supervise, direct or otherwise authorize or sanction dental hygienists, dental assistants and other staff as required by applicable legislation and standards. With additional training, dentists may specialize; examples include orthodontics, peridontics, pediatric dentistry, and public health. Dentists work in private practice or may be employed in hospitals, clinics, public health facilities or universities. Candidates must complete 2 to 4 years of predentistry university studies, followed by a 4 year degree from a recognized Dental program, in which a Doctor of Dental Surgery (DDS) or Doctor of Medical Dentistry (DMD) is obtained. Ontario has two accredited dental education programs: University of Western Ontario and University of Toronto. An accredited residency program of at least 1 year is required for dentists who wish to specialize in a particular field of dentistry. All dentists practising in Ontario must be licensed with the Royal College of Dental Surgeons of Ontario. Candidates must successfully complete an Ethics and Jurisprudence Exam and certification with the College. Also, Certification by the National Dental Examining Board is required. Patients do not require a referral to receive dental care. A barrier to access in private dental offices is most dental procedures are not covered by OHIP. However, many private insurance companies provide coverage for dental procedures, which are often through workplace benefit packages. In the event an individual is hospitalized in a public acute care hospital and the services of a dentist is medically necessary, OHIP will cover the procedure(s), usual postoperative care and one postoperative discharge follow up visit. 20 Royal College of Dental Surgeons of Ontario: The governing body for dentists in Ontario, with regulation, standards of practice and registration information contained at its website. Ontario Dental Association: Represents a voluntary professional organization representing 80% of dentists in Ontario. The website promotes the attainment of good oral health for Ontarians. Canadian Dental Association: Provides several program areas on its website as resources for dentistry and the public. Section 1: What are Regulated Health Care Professions? Page 11

20 Fact Sheet: Denturist Denturist NOC Number(s) 3221 Description Responsibilities 15 Employment Educational Requirements Other Professional Requirements Access Professional Associations and Related Websites Denturists are dental health professionals who specialize in the field of removable oral prosthesis (dentures). In partnership with other health care professionals, they assess, design, construct, repair and insert complete dentures, partial dentures and removable implant retained dentures. Services include dentures, mouth guards and antisnoring devices. 15 Denturists work directly with patients, independently or in collaboration with other health care professionals. In general, they: examine patients teeth, gums and surrounding tissue to diagnose disease, injury and decay and plan appropriate treatment; perform the intraoral (in mouth) procedures and laboratory procedures required to design dentures (impressions); insert dentures to fit patients comfortably and properly; and repair, reline and adjust dentures as required. Denturists work with dental instruments and machinery. They also use a variety of materials during the process of constructing dentures such as waxes, metals, porcelains and chemical solutions. Denturists choose to either establish a private clinical practice or associate with other denturists/dental health providers. Denturists are specially trained in both clinical and laboratory aspects of fabricating dentures to suit the needs of every individual. There is one accredited program in Ontario at George Brown College in Toronto. Candidates receive an Ontario College Advanced Diploma after 3 years (6 semesters). Graduates of the denturist program must successfully complete the licensing examination to be eligible for registration by the College of Denturists of Ontario. Denturists can be directly accessed by patients requiring their services. College of Denturists of Ontario: This website offers regulation, governance and development of the profession. Denturists Association of Ontario: This website is intended to be a centre of information for denturists and the public. Denturist Association of Canada: This website is currently under construction but does provide information on its education congress. Page 12 Section 1: What are Regulated Health Care Professions?

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